Plaster and splinting.
A 24yr old man has his dislocated ankle and displaced bimalleolar fractures reduced sucessfully in the ED. He has a stirrup and posterior backslab applied. What is the most critical principle to ensure the fracture reduction is maintained?
3 point moulding opposes the forces looking to distract the fracture elements. Do not do a circumferential cast because of the risk of ischemia.
When putting on a thumb spica splint in a patient with a scaphoid fracture which joints must be immobilised?
This option immobises the thumb whilst getting the fingers free.
A patient returns to the ED 4 hours after a fibreglass short leg plaster was applied for a closed fractured fibular. He has severe pain disproportiate to the injury. His foot pulses are present but capillary return is delayed. What should you do?
Classic symptoms and signs of a compartment syndrome. The fibreglass needs to be split and cut the stockingette cut down to the skin as the stockingette can cause constriction, not just the cast.
You are applying a posterior below knee slab in a patient with a fracture associated with significant swelling. How far proximal should the slab terminate to prevent peroneal nerve compression?
The common peroneal neck wraps superficially around the neck of the fibula so you need to have your backslab terminate well before the fibula neck. Compression of the common peroneal nerve will cause a foot drop.
Antonius Mathusen, a Dutch military surgeon, developed plaster to splint fractures in 1852. What animal did he test it on?
His ground breaking work paved the way for the technique to be used in the Crimean war which saved thousands of limbs from amputation.
Which of the following is correct when giving advice to patients who have had a fibreglass plaster or backslab applied?
The padding under the fibreglass is unlikely to be water proof. Increase in pain or paresthesia needs review as the patient may be developing a compartment syndrome.
When applying a u slab for a humeral shaft fracture the plaster keeps sliding distally before setting. What is the most effective technique to minimise this?
(Image thanks to ECI).
Below is a link for the excellent ECI video on how to apply a u slab. One additional thing is that it is bloody painful---consider using Ketamine IV to assist.
What is the "Position of Safe Immobilisation" (POSI)?
POSI is designed as a position to prevent contractures and long term stiffness during healing after wrist or hand injuries.
Which of the following is NOT true about Dynacast backslabs?
Use cool or room temperature water because with very warm water it will activate too quickly and the exothermic reaction may even cause minor burns.
Why is the word "Paris" in Plaster of Paris?
The boom in the use of plaster in Paris occurred in the 1700s when the French king ordered the wooden buildings to be covered in local gypsum plaster for fire safety.